Hybrid Treatment for Complex Lesions in a 92-year-old Patient with Arteriosclerosis Obliterans of the Lower Extremity

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 80; no. 8; pp. 1443 - 1448
• Main Authors: OKANO, Takahisa, FUJIWARA, Katsuji, YAKU, Hitoshi
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2019
• Subjects: elderly patient; hybrid arterial reconstruction; peripheral arterial disease
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.80.1443

A 92-year-old man with a right proximal tibiofibular fracture underwent plate fusion via a lateral incision in the right calf in our hospital's Department of Orthopedic Surgery. In postoperative week 3, the wound site became dehiscent. A plastic surgeon carried out a skin graft to repair the skin defect after the use of a medial gastrocnemius flap and negative pressure wound therapy, but granulation was poor. Computed tomography (CT) contrast angiography showed multiple severe stenoses in the iliac artery region and the arteries of the legs, and arteriosclerosis of the lower extremities with multisegmental complex lesions was diagnosed. Our department judged that revascularization should be performed as rapidly as possible to save the leg, and a left external iliac artery-right popliteal artery bypass was performed. On day 6 after the bypass, the stenoses in the left external iliac artery and the common iliac artery were stented. The ankle-brachial index (ABI) improved, granulation tissue growth at the ulcerated site was good, and in postoperative week 3, the wound was closed with a skin graft. A case of complex lesions in an oldest-old patient with arteriosclerosis obliterans of the lower extremities, a disorder that is expected to become more common in the future, which was successfully treated with multimodal therapy consisting of hybrid revascularization and skin grafting by a plastic surgeon, is reported.